Permit iih,,,...:: CITY OF TIGARD ELECTRICAL PERMIT
-, COMMUNITY DEVELOPMENT Permit #: ELC2010 -00178
r,•P t 1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/26/2010
ZIGARD. 9 Parcel: 2S112DA01200
Jurisdiction: Tigard
Site address: 15060 SW SEQUOIA PKWY
Subdivision: Lot: 0
Project: Office Depot
Project Description: 4 Sign Lighting
Owner: FEES
PACIFIC REALTY ASSOCIATES Quantity Description Date Amount
15350 SW SEQUOIA PKWY #300
PORTLAND, OR 97224 4 ea Sign or Outline Lighting 04/26/2010 $271.36
4 ea 12% State Surcharge - 04/26/2010 $32.56
PHONE: 503 - 624 -6300 Electrical
Contractor:
MEYER SIGN CO OF OREGON INC
15205 SW 74TH AVE
TIGARD, OR 97224
PHONE: 503 - 620 -8200
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $303.92
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 9 2 - 1 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: g
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application ' i t - €'',I . • FOR OFFICE USE ONLY
C i t y of T igard R
Permit No.: EL c., e
III - ° 13 125 S W Hall Blvd., Tigard, OR 97223 P R 2 ! Q Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 Date /B : %�
Inspection Line: 503.639.4175 66' 4 ( v +~r, v - •• �. ^, t `Date Read /B r orris: 171 See Paget for
TIGARD Internet: www.tigard- or.gov P li }} ' ° " ' Notifie d/Method: Supplemental Information
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TYPE OF WOR PLAN REVIEW
❑ New construction ❑ Addition/altLtion/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition )6 Other: •r 4 S where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Tess to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I - 2", "1 - 3 ",
Q L 100HP or more. occupancy.
Job no.: Job site address: 150 S(,,J Se / an/ •
d+ r/�C/+ / ❑ Six or more residential units. ❑ Recreational vehicle parks.
Cit /State /ZIP: 7 (1 / ❑ Health -care facilities. ❑ Supply voltage for more than
y / �"L ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Q, .!`T1 "` a ' "- yj� 1, ❑ Service or feeder 600 amps or more.
� 7 . � FEE SCHEDULE
Oss stfee ections to job site: C h 1 �� Description 1 QM Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: ! a a 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK
(with above sq. ft) 67.84 2
Limited energy, multi - family 67.84 2
-� ..- l �� ,/ • l residential (with above
Gt/a.l� S. �`— �y' t—� ,2_,
Services or feeders installation, n, alteration, and /or relocation
(rr/ 200 amps or less 100.70 2
❑ PROPERTY OWNER TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: ot. , ( U '` `_` , l�•L JP 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, Qer panel
Owner signature: Date: A. Fee for branch circuits with
A APPLICANT O CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: . Fee for branch circuits without { C co O service or feeder fee, first 56.18 2
Contact name: ! / branch circuit _
_ �� ��-� Cl Each add'I branch circuit 7.42 2
Address: ' e J o 5 5 7li - _ Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State /ZIP: - 7I.5 4-r J ' Ox _ dwelling, service and/or feeder
Phone: (S ')J) 34, I) _ �'
/ 0 Fax: ( ) 3 6 ci -41 3!S Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - L S yar y ,
y� — b v -1, - , (DS. Cb v -1, - , f,ig or outline lighting ,71
67.84 ,1,/. 41.0 2
f CONTRACTOR ignal circuit(s) or limited- energy
Business name: panel, alteration, or extension. Page 2 2
JI C Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: Industrial plant (1 hr min) 78.18/ hr
Phone: (g 3) (0 Z) --g . 00 Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (%2 hr min)
!
CCB Lic.: 1 4 l o / y I Electrical Lic.: ;;‘ no as Suprv. Lic.: sa i, 6 (t, ELECTRICAL PERMIT FEES fe
1 4t � ( it* 1 1/ Subtotal: a " ] , • 2
Suprv. Electrician sight , required: t I/ f) f Plan review (25% of permit fee):
Print name: `iiyliki '""" Q,, A/ � S Date: ,�/ /`0 State surcharge (12% of permit fee): 3 ' . O
/ � , . TOTAL PERMIT FEE: *3 p3, t
Authorized signature: "i/ f f j This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
1:\ Building \ Permits \ELC- PermitAPP.doc 10/01/09 440- 4615T(11 /05 /COM/WEB